Provider Demographics
NPI:1598310179
Name:ANGELO KIDNEY CONNECTION HOME THERAPIES PLLC
Entity Type:Organization
Organization Name:ANGELO KIDNEY CONNECTION HOME THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-450-4445
Mailing Address - Street 1:PO BOX 61074
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76906-1074
Mailing Address - Country:US
Mailing Address - Phone:325-617-2496
Mailing Address - Fax:
Practice Address - Street 1:3626 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-3994
Practice Address - Country:US
Practice Address - Phone:325-617-2469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment